Interstate Endorsement Forms - Minnesota Department of …

Interstate Endorsement Forms Minnesota NURSING ASSISTANT REGISTRY Please follow directions carefully. Incomplete Forms will delay your transfer to the Minnesota Registry. All incomplete Forms will be returned to the address you listed on the Forms . 1. Complete Section A-1 and send this form to the state registry from which you are transferring. For your convenience, a list of Nurse Aide Registries is on the second page. ATTENTION: If you are transferring from one of the following states: California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Missouri, North Carolina, North Dakota, Tennessee, Virginia, or Wisconsin complete Section A-1 and mail this form to the Minnesota Registry. 2. Complete Section B-1, attach items needed and send to your last/current facility where you worked/work in the state from which you are transferring.

MISSISSIPPI PO Box 64501. PearsonVue/Nursing Assistant Registry . PO Box 13785 Philadelphia, PA 19101-3785 . 800 -204 6213. MISSOURI *SEND TO MINNESOTA* MN Dept. of Health Nursing Asst. Registry PO Box 64501 . St. Paul, MN 55164-0501. Phone # for VA Registry: Phone # for MO Registry:-5686. MONTANA . Human Svcs. Certification Bureau P. O Box ...

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